Veristride Inc. ? Project Summary When surveyed, 90% of stroke survivors said the ability to ?get out and about? is considered between important and essential for a better life. However, that desire falls short of reality for most stroke survivors. Often, walking across a neighborhood street or from a car to a home is an insurmountable task with little opportunity for working on improvement in gait. Once insurance coverage for physical therapy has ended (generally six months after the stroke), the stroke survivor is expected to continue to improve their functional mobility at home, but the monitoring is self-assessment, with no professional assistance for most people. Enabling anyone with mobility issues to work on improving their gait at home has the potential to improve quality of life and reduce fall risk. This Phase I STTR proposes combining patented technologies to create a new product for stroke survivors to use at home, called STEP-R (Step Training Enhances Performance with Rhythmic auditory/verbal cues). This technology builds on Veristride's existing PTMetrix product (HIPAA-compliant and registered with the FDA), which has been brought to market with SBIR support. Veristride will partner with the University of Maryland- Baltimore to incorporate cues based on the stride length/velocity ratio, which is key to improving gait quality. STEP-R will provide novel interactive rhythmic auditory plus verbal cueing with two major innovations: interactive auditory cues that adjust based on real-time measurements of walking interspersed with short verbal cues (e.g., ?take bigger steps?) that provide instructions like a physical therapist's advice in the clinic. STEP-R uses these adapting cues and alternating advice to improve gait quality long-term by adapting to new stride-length/velocity ratios, a key component of gait quality, using the verbal advice to guide the patient when to respond or maintain a new motor pattern. The Specific Aims include Aim 1: Developing a working clinically-valid prototype of STEP-R, consisting of adapting and integrating the existing Veristride system to include real-time analysis and verbal cues along with clinical validation with chronic stroke survivors, and Aim 2: Evaluating STEP-R with the same chronic stroke survivors in a home environment feasibility trial, and investigating user feedback among these stroke survivors and physical therapists who treat stroke to evaluate the use of STEP-R with sub-acute patients in the clinic. Meeting milestones and preliminary efficacy data will provide statistical powering for a Phase II clinical trial.